RECORD OF PROCEEDINGS
PHYSICAL DISABILITY BOARD OF REVIEW

NAME:  XXXXXXXXXXXXXXXXXXX	CASE:  PD-2015-01207
BRANCH OF SERVICE:  Army 	SEPARATION DATE:  20021220

SUMMARY OF CASE:  Data extracted from the available evidence of record reflects that this covered individual (CI) was an active duty E4, Network Switching Systems Operator, medically separated for “left knee, retropatellar pain syndrome,” with a disability rating of 0%.  

CI CONTENTION:  “Since separation my injuries have prevented me from an active lifestyle.  As over the past 12 years my knees do not allow me to run for long distances.”  The CI’s complete submission is at Exhibit A.  

SCOPE OF REVIEW:  The panel's scope of review is defined in DoDI 6040.44.  It is limited to review of disability ratings assigned to those conditions determined by the Physical Evaluation Board (PEB) to be unfitting for continued military service and when specifically requested by the CI, those conditions identified by the PEB, but determined to be not unfitting or non-compensable.  Any conditions outside the panel’s defined scope of review and any contention not requested in this application may remain eligible for future consideration by the panel for Correction of Military Records.  Furthermore, the panel’s authority is limited to assessing the fairness and accuracy of PEB rating determinations and recommending corrections, where appropriate.  The panel’s assessment of the PEB rating determinations is based on review of medical records and all available evidence for application of the Veterans Affairs Schedule for Rating Disabilities (VASRD) standards to the unfitting medical condition at the time of separation.  The panel has neither the role nor the authority to compensate for post-separation progression or complications of service-connected conditions.  That role and authority is granted by Congress to the Department of Veterans Affairs, operating under a different set of laws.  The panel gives consideration to VA evidence, particularly within 12 months of separation, but only to the extent that it reasonably reflects the severity of the disability at the time of separation.   

RATING COMPARISON:  

SERVICE PEB - 20021113	VARD - 20030523	
Condition	Code	Rating	Condition	Code	Rating	Exam	
Left Knee, Retropatellar Pain Syndrome 	5099-5003	0%	Left Knee Condition with Scar	5099-5020	10%	20030319	
COMBINED RATING:  0%	COMBINED RATING OF ALL VA CONDITIONS:  10%	

ANALYSIS SUMMARY:  

Left Knee, Retropatellar Pain Syndrome.  According to service treatment records (STR) and the Medical Evaluation Board (MEB) narrative summary (NARSUM), the CI’s left knee condition began in May 1999, after a twisting injury.  Orthopedic surgery was consulted for the CI’s left knee pain.  He was diagnosed with possible meniscal tear versus retropatellar pain syndrome ([RPPS] symptom complex of anterior knee pain involving the patella).  The 31 May 2002 left knee diagnostic arthroscopy revealed synovial membrane (synovial fluid secreting dense connective-tissue membrane that lines joint capsules and tendon sheaths) inflammation (reactive synovitis) and a synovial debridement was performed.  The articular cartilage, menisci, and cruciate ligaments all appeared to be without injury.  Following surgery further treatment did not result in improvement sufficient to allow unrestricted duty.  The MEB forwarded “left knee pain secondary to retropatellar pain syndrome” and “synovitis about the interior left knee on arthroscopic findings” for PEB adjudication.  

The 12 September 2002 NARSUM, 3 months before separation, noted complaints of persistent knee pain.  The left knee examination revealed a well-healed incision and patellofemoral joint and medial joint line tenderness.  There was a normal Q angle (angle between the quadriceps muscles and the patella tendon), normal patellar tracking, no effusion (fluid collection), and no swelling.  Range of motion (ROM) showed a normal flexion of 140 degrees and a normal extension of 0 degrees.  The patellar grind (assesses abnormal patellar movement and painful crepitation) test was positive and the patellar apprehension (apprehension or pain on quadriceps contraction with patella displaced) test was negative.  The flexion pinch (assesses medial synovial plica [synovial membrane fold]) test was positive.  The Apley compression (assesses menisci), anterior drawer (assesses anterior cruciate ligament [ACL]), Lachman (assesses ACL), and valgus/varus stress (assesses medial collateral ligament [MCL]/lateral collateral ligament [LCL]) tests were negative.  “He is unable to pivot shift [pivot shift assesses ACL].”  Strength and sensation were normal.  The diagnosis listed left knee pain secondary to RPPS and synovitis by arthroscopy.  

At the 19 March 2003 VA Compensation and Pension (C&P) examination, 3 months after separation, the CI complained of pain and stiffness in his left knee.  The physical examination documented a normal gait, no unusual shoe wear pattern, and no functional limitation on walking or standing.  The left knee examination revealed an arthroscopic surgery scar with no tenderness, deformity, redness, heat, edema (excess tissue fluid swelling), effusion, instability, weakness, ankylosis, abnormal movement, or guarding of the movement.  There was painful motion at about 120 degrees of flexion.  There was no limitation of movement from pain, fatigue, or lack of endurance.  The diagnosis listed left knee injury status post synovial debridement surgery.  Left knee radiographic (X-rays) studies on 19 March 2003 revealed a moderate size exostosis (benign cartilaginous outgrowth on a bone) at the proximal tibia shaft, maintained joint space, and no acute fractures.

The panel directed attention to its rating recommendation based on the above evidence.  The PEB rated the left knee condition 0%, coded 5099-5003 (degenerative arthritis), citing that the cartilages and ligaments were intact.  The VA rated the left knee condition 10%, analogously coded 5099-5020 (synovitis), citing painful or limited motion.  The panel concluded there was no limitation of motion which supported a rating under the diagnostic codes for limitation of flexion or extension (5260, 5261).  The examinations proximate to separation did not demonstrate the presence of ligamentous instability or laxity (5257), and there was no history of dislocated meniscus or loose body causing frequent locking with recurrent effusions (5258), or history of surgery to remove a meniscus (5259) to support a rating under the respective codes.  There was no fracture, non-union, or malunion of the femur or tibia to support consideration under the respective codes for knee impairment related to long bone conditions (5255, 5262).  There were no grounds for additional rating based on the presence of instability.  However, the panel agreed a 10% rating was supported based on VASRD §4.40 (functional loss) or §4.59 (painful motion).  After due deliberation, considering all of the evidence and mindful of VASRD §4.3 (reasonable doubt), the panel recommends a disability rating of 10% for the left knee condition.  

BOARD FINDINGS:  In the matter of the left knee, retropatellar pain syndrome condition, the panel unanimously recommends a disability rating of 10%, coded 5099-5003 IAW VASRD §4.71a.  There were no other conditions within the panel’s scope of review for consideration.  

The panel recommends that the CI’s prior determination be modified as follows, effective as of the date of the prior medical separation:  

CONDITION	VASRD CODE	PERMANENT RATING	
Left Knee, Retropatellar Pain Syndrome	5099-5003	10%	

The following documentary evidence was considered:

Exhibit A.  DD Form 294, dated 20150615, w/attachments
Exhibit B.  Service Treatment Record
Exhibit C.  Department of Veterans Affairs Treatment Record

AR20170011790, XXXXXXXXXXXXXXXXXXX

XXXXXXXXXXXXXXXXXXX

Dear XXXXXXXXXXXXXXXXXXX:

	The Department of Defense Physical Disability Board of Review (DoD PDBR) reviewed your application and found that your disability rating should be modified but not to the degree that would justify changing your separation for disability with severance pay to a permanent retirement with disability.  I have reviewed the Board’s recommendation and record of proceedings (copy enclosed) and I accept its recommendation.  This will not result in any change to your separation document or the amount of severance pay.  A copy of this decision will be filed with your Physical Evaluation Board records.  I regret that the facts of the case did not provide you with the outcome you may have desired.
  
	This decision is final.  Recourse within the Department of Defense or the Department of the Army is exhausted; however, you have the option to seek relief by filing suit in a court of appropriate jurisdiction. 

	A copy of this decision has also been provided to the Department of Veterans Affairs.

Sincerely,	
Enclosure